Relestat (Adrenaline)

Adrenaline

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Method of action: Antiallergic, Bronchodilator, Cardiac Therapy, Drugs For Obstructive Airway Diseases, Hyperglycemic, Hypertensive, Vasoconstrictive

Treatment option: Allergic Reactions, Allergy, Anaphylaxis, Angioedema, Asthma, Bronchospasm, Hypotension, Jock Itch, Hives, Syncope

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Overview of Relestat (Adrenaline)

Relestat is the trade name for a powerful prescription-only medicine whose active ingredient is Adrenaline, which is also known by the scientific name Epinephrine. As a critical rescue medication, its general purpose is to rapidly reverse life-threatening physiological collapse in acute emergencies. The substance is considered an essential medicine.

Quick Facts	Description
Active ingredient	Adrenaline (Epinephrine)
Form	Aqueous Solution for Injection
Pharmacological class	Sympathomimetic agent, Alpha- and beta-adrenergic agonist
General purpose	Rapid stabilization in systemic emergencies
Origin	Endogenous hormone, produced synthetically for medicinal use

The Fundamental Identity of Relestat: Adrenaline (Epinephrine)

Relestat contains the single active ingredient Adrenaline, classifying it as a Sympathomimetic agent and a non-selective Alpha- and beta-adrenergic agonist. This pharmacological group is clinically recognized for its critical role in stimulating both vascular and pulmonary systems during acute crises. While Adrenaline is an endogenous hormone naturally produced by the adrenal glands, the substance utilized for pharmaceutical treatment is produced synthetically to ensure high purity and reliable potency.

Composition and Delivery Type

Adrenaline is formulated as a sterile Aqueous Solution for Injection, typically supplied in sealed ampoules or pre-filled devices. The product is designed for parenteral administration (outside the digestive system). This specialized formulation is essential for achieving the rapid onset of action required in critical situations, differentiating it clearly from medications intended for slower, oral absorption.

General Purpose as a Rescue Medication

The primary general purpose of this potent agent is to rapidly stabilize a patient during acute, systemic physiological events, such as a severe systemic allergic reaction. Adrenaline achieves this by simultaneously promoting strong vasoconstriction (narrowing blood vessels) to increase critically low blood pressure, and powerful bronchodilation (widening airways). These combined actions provide immediate circulatory and respiratory support, serving as the essential pharmacological tool for restoring immediate function in an emergency setting.

Regulatory References

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What side effects are possible with Relestat (Adrenaline)?

Possible side effects and safety information

The official safety profile for Adrenaline (Epinephrine) is defined by its strong systemic effects, with adverse reactions documented across multiple body systems. The occurrence and severity of these effects are explicitly stated in regulatory documents as being dependent on the individual patient's sensitivity and the dose administered.

Adverse Reaction Classification

Adverse reactions are primarily concentrated in the Cardiac disorders and Nervous system disorders System-Organ Classes. Effects that are frequently listed in regulatory documents, often with a classification of Common or Frequency Not Known, include anxiety, tremor, headache, dizziness, pallor, sweating, palpitations, and tachycardia.

Documented Serious Adverse Reactions

The regulatory label documents severe, clinically significant adverse reactions that, while rare, represent critical risks. These serious effects include life-threatening ventricular fibrillation and other severe arrhythmias, myocardial infarction, and cerebral hemorrhage, particularly when associated with a rapid, extreme rise in blood pressure. Serious infections, such as necrotizing fasciitis, have also been reported at injection sites.

Population-Specific Safety Considerations

Official safety documentation identifies specific patient populations as being more susceptible to certain risks. Older adults are noted to be at a higher risk of adverse cardiovascular events, including acute hypertension leading to hemorrhage. Patients with pre-existing conditions such as Ischemic Heart Disease, hyperthyroidism, or diabetes mellitus are also officially noted to be at greater risk for serious cardiovascular or metabolic reactions, such as transient increases in blood sugar (hyperglycemia).

High-Level Safety Constraints

The adverse effects are generally rapidly transient; however, inadvertent injection into certain areas (e.g., fingers or toes) may result in localized loss of blood flow. Safety notes also highlight that certain high-level drug interactions, such as with non-selective beta-blockers, can severely potentiate pressor effects.

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Overdose and Emergency Response

Overdose with Adrenaline, often resulting from procedural errors, typically leads to a rapid onset of severe effects. Given the serious nature of its action on the cardiovascular and nervous systems, immediate medical attention is required for any suspected overdose.

Documented Overdose Manifestations

Symptoms are usually characterized by hyperactivity of the body's systems, primarily affecting the heart. Documented presentations include:

Cardiovascular: Disturbances of cardiac rhythm and rate (such as palpitations and tachycardia), chest pain, and severe hypertension, which carries a risk of cerebral haemorrhage. The most serious outcomes include potentially fatal ventricular arrhythmias and fibrillation, as well as stress cardiomyopathy.
Nervous System: Central nervous system effects are common and include agitation, anxiety, fear, headache, dizziness, and tremors.
Metabolic: Overdose can lead to metabolic acidosis and significant changes in blood sugar, such as hyperglycaemia.

Emergency Actions and Overdose Risk

The severity of effects is related to both the dose administered and the individual's sensitivity. In an overdose situation, monitoring key vital signs like the patient's pulse, blood pressure, ECG (Electrocardiogram), and oxygen saturation is essential for assessment and guidance of medical intervention. Repeated local injections are associated with a risk of necrosis at the injection site.

Patients with certain pre-existing conditions, such as coronary insufficiency, Parkinsonian Syndrome, or those undergoing general anaesthesia with halogenated agents, may be at higher risk for severe cardiovascular or neurological symptoms during exposure to excessive levels of Adrenaline. The need for specialized medical support is paramount, as treatments for overdose often involve managing critical, life-threatening cardiovascular effects.

Therapeutic Uses of Relestat (Adrenaline)

What Relestat (Adrenaline) Treats: Main Uses and Benefits

Relestat, which contains the active ingredient Adrenaline (Epinephrine), is commonly used across domains where additional symptomatic support is needed. It is relevant in situations where short-term symptomatic assistance is appropriate across conditions involving heightened physiological stress.

This medication is applicable in clinical scenarios associated with conditions such as severe allergic reactions (anaphylaxis), symptoms related to severe systemic imbalance, and acute airway obstruction. It assists with managing symptoms that create noticeable physiological strain and is often used during phases when symptoms become more disruptive.

Key Symptom Domains and Benefits

The primary therapeutic domains involve symptomatic relief across areas that include manifestations of systemic discomfort and acute physiological strain. This includes managing symptoms of severe low blood pressure, providing symptomatic assistance for rapid airway closure, and quickly addressing the multi-system manifestations of severe allergic episodes.

Quick Fact	Supportive Symptom Domain
Systemic Support	Helps address symptom clusters related to severe systemic discomfort.
Respiratory Assistance	Supports easing distress from acute breathing difficulties and airway obstruction.
Symptom Stabilization	Contributes to maintaining functional stability during episodes of acute allergic reactions.

“The medication supports the patient during difficult episodes by easing distress and assists with maintaining functional stability when symptoms are more noticeable.”

Regulatory References

NIH MedlinePlus overview

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Eligibility and Restrictions for Use

Eligibility Scope

Populations for whom use is allowed (as stated in label):

Adults and Pediatric Patients for emergency treatment of Type I allergic reactions (anaphylaxis).

Populations for whom use is contraindicated:

Patients with known hypersensitivity to the active substance or its components.
Use is generally restricted in non-emergency settings for patients receiving nonselective beta-blockers, due to the risk of severe blood pressure increase.

Age-related eligibility rules:

Pediatric Use: Supported via weight-based dosing; however, auto-injector use is often not established or recommended for children weighing less than 15 kilograms.
Geriatric Use (Older Adults): Caution is required, as older adults may be more susceptible to adverse reactions from the medicine.

Condition-specific eligibility rules:

Caution is required for patients with underlying heart disease (e.g., coronary artery disease) or conditions like hyperthyroidism, diabetes mellitus, and Parkinson's disease.
Patients with Severe Renal Impairment should be administered the injection with caution.

Pregnancy and lactation eligibility status (if explicitly documented):

Pregnancy: Use is permitted only if the potential benefit justifies the potential risk to the fetus, and use should be avoided during the second stage of labor.
Lactation: Caution should be exercised when administered to a nursing mother.

Eligibility Classifications (High-Level)

Eligibility severity classification (as defined in official documents):

Classification	Examples of Affected Populations/Conditions
Contraindicated	Hypersensitivity, concurrent nonselective beta-blocker use (non-emergency)
Caution Required	Underlying Heart Disease, Elderly Patients, Pregnancy, Severe Renal Impairment
Not Recommended	Pediatric patients under 15 kg (for auto-injector devices)

Connection to the overall eligibility profile:

Official regulatory documents define the eligibility profile by confirming allowed use in adult and pediatric emergency populations while simultaneously mandating specific restrictions. These restrictions range from absolute contraindications to cautions required for patients with pre-existing conditions and limitations related to age and physiological status.

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What should I know about interactions with other medicines?

Interactions with other medicines and products

Official regulatory documentation structures the interaction profile of Adrenaline (Epinephrine) around two main patterns: potentiation and antagonism. No specific timing separation rules or absolute contraindicated combinations are typically cited in regulatory labels for this emergency medication, though caution is mandated for co-administration.

Pharmacodynamic and Metabolic Interaction Patterns

Co-administration with several medicinal product categories can alter Adrenaline’s effect on the cardiovascular system. These interactions are categorized based on their documented outcomes:

Potentiation and Increased Risk: Medicines that inhibit the metabolic breakdown of Adrenaline, such as Monoamine Oxidase Inhibitors (MAOIs) and COMT Inhibitors (e.g., Entacapone), are documented to potentiate pressor effects, raising the risk of severe, prolonged hypertension. Tricyclic Antidepressants (TCAs) and certain Exogenous Thyroid Hormones also increase this risk.
Arrhythmogenic Risk: Official documents note that co-administration with agents like Halogenated Hydrocarbon General Anesthetics (e.g., Halothane) or Cardiac Glycosides may increase the risk of cardiac arrhythmias.
Antagonism of Effects: Beta-Adrenergic Blocking Drugs and Alpha-Adrenergic Blocking Drugs may antagonize the desired cardiovascular and respiratory actions of Adrenaline, resulting in reduced efficacy.

Population-Specific Interaction Notes

Official labeling indicates that elderly patients receiving potent pressor-potentiating drugs like MAOIs or TCAs may face an officially documented higher risk of severe, prolonged hypertension. No specific interactions are documented with food, alcohol, or herbal products for the injectable form.

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Mechanism of Action

Relestat, containing Epinastine, is a pharmacologic agent targeting multiple receptors and cellular processes primarily within ocular tissues following topical administration. Epinastine functions as a direct antagonist at the histamine H1 receptor, exhibiting a high binding affinity. It also possesses affinity for the histamine H2 receptor and alpha1-, alpha2-, and 5-HT2 receptors, with low affinity for cholinergic and dopaminergic sites.

The primary mechanism involves competitive antagonism of histamine at the H1 receptor, preventing endogenous histamine from initiating its signaling cascade. Intracellularly, Epinastine modulates the cellular response of mast cells, resulting in a stabilizing activity that inhibits the release of preformed and newly synthesized inflammatory mediators, including histamine itself. This molecular action restricts the local accumulation and activity of inflammatory cells. The system-level physiological consequence of H1 antagonism and mediator release inhibition is a localized reduction of the vascular and cellular inflammatory processes within the anterior segment of the eye.

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Dosage and Administration Information

How to Use Relestat (Adrenaline): Official Administration Guidelines

Adrenaline (Epinephrine) administration is defined by clinical protocols that specify the precise route, dosage, and timing for its use in emergency and critical care settings. The usage protocol varies based on the context of administration, requiring a specific approach for each official route.

Administration Scope	Standardized Guidelines
Route of Administration	Intramuscular (IM) into the anterolateral thigh is the preferred route for acute emergencies; Intravenous (IV) infusion is used for specific critical care scenarios.
Standard Adult Dosing	IM/SC: 0.3 mg to 0.5 mg of the undiluted solution, with a maximum single dose of 0.5 mg. IV Infusion: Titrated continuous infusion starting typically from 0.05 mcg/kg/min to 2 mcg/kg/min.
Dosing Frequency	The IM/SC dose may be repeated every 5 to 15 minutes as necessary, based on the patient’s clinical response.
Preparation	For IV infusion, the 1 mg/mL solution must be diluted in a dextrose-containing solution (e.g., 5% Dextrose) to achieve a concentration of 1 mcg/mL prior to delivery.

Procedural and Population Rules

Pediatric Dosing: Dosage is weight-based. For IM/SC, patients under 30 kg receive 0.01 mg/kg up to a maximum of 0.3 mg per injection, or a fixed 0.15 mg dose via auto-injector for the 15 kg to 30 kg range.
Administration Site: All IM and SC injections must be given into the anterolateral aspect of the thigh; use of a needle at least 1/2 inch in length is specified to ensure delivery into the muscle.
Infusion Tapering: Continuous intravenous infusions are generally required for sustained periods (hours or days) and must be incrementally weaned over time after the patient's condition stabilizes.

These instructions establish the precise parameters—route, dose, and frequency—that are followed to ensure the medication is used according to standardized procedures.

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Recent Clinical Evidence

Research Evidence / Overview of Studies for Relestat (Adrenaline)

Evidence for Use in Severe Systemic Allergic Reactions (Anaphylaxis)

The research base for Adrenaline in the emergency setting for severe, life-threatening allergic reactions, known as anaphylaxis, has been established through long-term observation and regulatory consensus. Due to the critical and immediate nature of the condition, ethical factors have precluded researchers from conducting large-scale, placebo-controlled randomized trials. Instead, evidence has been derived from consistent observational cohort studies and analyses of medical registries.

These studies monitored outcomes related to systemic or functional imbalance, such as the measurement of blood pressure and acute breathing difficulties or airway swelling. The evidence provides context for the immediate symptom patterns, but the lack of controlled trials means the research is limited in certain areas. Long-term outcomes tracked specifically to the immediate administration are not fully established.

Evidence for Use in Out-of-Hospital Cardiac Arrest (OHCA)

Adrenaline was evaluated in large randomized controlled trials (RCTs) for its use during cardiac arrest that occurs outside of a hospital setting. Research examined short-term results, such as measurements related to the restoration of a heartbeat, and long-term measures, including survival to hospital discharge and neurological status.

Randomized trials reported measurements related to the achievement of spontaneous circulation and short-term survival rates. However, long-term functional recovery and neurological outcomes were reported inconsistently across studies. The results apply only to the populations studied, and certainty remains low regarding the functional status after hospital discharge.

What Remains Uncertain About Relestat (Adrenaline) in Research

Evidence quality varies across studies, and significant limitations exist. For conditions like cardiac arrest, the findings were mixed, particularly concerning long-term functional recovery. For anaphylaxis, comparative evidence is lacking. Follow-up durations were limited across much of the research, meaning long-term effects are not fully established.

Key Studies & References

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Frequently Asked Questions (FAQ)

Common questions about Relestat (Adrenaline) (FAQ)

Q: What is the main reason doctors prescribe Relestat (Adrenaline)?

A: Official information describes the drug's primary and essential use as the emergency treatment for severe allergic reactions. This includes anaphylaxis, which is a life-threatening, whole-body allergic reaction.

Q: Is Relestat (Adrenaline) the same as the epinephrine in an auto-injector?

A: Official health bodies recognize adrenaline and epinephrine as two different names for the exact same chemical ingredient. The ingredient is chemically identical, which is noted by official bodies.

Q: Why is it called both Relestat and Adrenaline?

A: Regulatory bodies note that 'Adrenaline' and 'Epinephrine' are international names for the same chemical substance. Official bodies use both names, noting that they are internationally recognized terms for the same substance.

Q: Does Relestat (Adrenaline) help with general anxiety or panic attacks?

A: The approved indications for this medicine do not include the treatment of general anxiety or panic attacks. In fact, official documents list anxiety, fear, and restlessness as potential side effects of the medication itself.

Q: How quickly is Relestat (Adrenaline) supposed to start working after use?

A: Adrenaline is a fast-acting, emergency medicine. Official product information states that the therapeutic effects begin rapidly after intramuscular injection. The drug is designed to achieve peak concentrations quickly to counteract acute, severe symptoms.

Q: What are the most common feelings or sensations people experience right after using it?

A: Regulatory information indicates that common sensations can include anxiety, restlessness, dizziness, tremor (shaking), and headache. These are the result of the drug's action as a sympathomimetic amine.

Q: Is it normal to feel shaky or nervous after a dose of Relestat?

A: Yes, official regulatory information lists tremor (shakiness), anxiety, and restlessness as expected and common reactions following administration. These feelings are the result of the drug's potent effects.

Q: Can Relestat (Adrenaline) be used for a persistent allergic reaction that isn't severe?

A: The drug is approved for the emergency treatment of severe allergic reactions, specifically anaphylaxis. Official documents emphasize that this medicine is intended for acute, life-threatening symptoms, not persistent, milder reactions.

Q: What happens if Relestat (Adrenaline) is used accidentally when it wasn't needed?

A: Accidental or inappropriate use, particularly injecting into the hands or feet, may cause localized vasoconstriction (narrowing of blood vessels). Official warnings emphasize that any accidental injection requires immediate professional medical attention.

Q: Does Relestat (Adrenaline) interact with common blood pressure medications?

A: Official documents describe that caution is necessary when the drug is used alongside certain blood pressure medications, as this can potentially result in severe hypertension (high blood pressure). Official product information specifically identifies non-selective beta-blockers as a class of interacting medicines that require caution.

Q: How long does the primary effect of Relestat (Adrenaline) usually last?

A: The drug's emergency effects are designed to be rapid and potent but short-lived. Regulatory documents note that the dose may need to be repeated after 5 to 15 minutes, which indirectly defines the expected short duration of its primary action.

Q: Is Relestat (Adrenaline) a cure for allergic reactions or just a temporary treatment?

A: Official documents consistently describe this medicine as the 'first-line, emergency treatment' for anaphylaxis. It is intended to temporarily reverse the life-threatening symptoms and is not a cure for the underlying allergy.

Q: Can taking cold and flu medicine interfere with Relestat (Adrenaline)?

A: Official warnings note that certain sympathomimetic agents, which are sometimes contained in non-prescription cold and flu preparations, can increase the risk of cardiovascular side effects when combined with Adrenaline. Regulatory documents emphasize the importance of informing a healthcare professional about all medicines.

Q: Do studies support the use of Relestat (Adrenaline) in children?

A: Yes, official drug documents include weight-based dosage guidelines specifically for pediatric patients. Expert bodies also recognize Adrenaline as the necessary first-line emergency treatment for anaphylaxis in children.

Q: Is it common for people to carry two Relestat devices/doses?

A: Official sources indicate that it is common for patients at risk of anaphylaxis to carry two devices. This is noted as a precaution in case a second dose is urgently required or if the first device is not sufficient.

Q: Does Relestat (Adrenaline) have any known interactions with herbal supplements?

A: Official regulatory information advises patients to inform their healthcare providers about all medicines, including herbal and other non-prescription supplements, that they are taking, as potential interactions may exist.

Q: Can someone who has certain psychiatric conditions use Relestat (Adrenaline)?

A: Official documents state that psychiatric conditions may be exacerbated by the effects of the medicine. Regulatory documents indicate that caution is advised for use in patients with conditions like psychoneurosis.

Q: Why do official documents mention certain medical conditions as a caution for Relestat use?

A: Regulatory documents state that caution is necessary because the drug's effects, such as increasing heart rate and blood pressure, may raise the risk of serious complications. This is especially true for patients with pre-existing conditions like cardiovascular disease or hyperthyroidism.

Q: Is Relestat (Adrenaline) considered a controlled substance?

A: Regulatory schedules for controlled substances list drugs with potential for abuse and dependency. Epinephrine/Adrenaline is not listed in these schedules and is generally not classified as a controlled substance by major regulatory bodies.

Q: If I have asthma, is there any special caution for using Relestat (Adrenaline)?

A: Official product information notes that some formulations contain sodium metabisulfite, an ingredient that may cause allergic-type reactions in susceptible individuals. This is why caution is mentioned for use in patients with asthma.

Q: What is the purpose of the liquid/solution inside the Relestat device?

A: The medicine is a sterile solution intended for injection. This solution contains epinephrine/adrenaline, which is the active ingredient that treats the allergic reaction, along with inactive ingredients used to stabilize and preserve the drug.

Q: How is Relestat (Adrenaline) different from the adrenaline produced naturally by the body?

A: The medicine contains the exact same chemical substance as the hormone naturally produced by the body. The difference is that the medicine is administered as a potent, targeted dose in an emergency to reverse life-threatening symptoms.

Q: Can alcohol consumption change how Relestat (Adrenaline) works?

A: Official warnings note that alcohol may enhance the effects of certain central nervous system active agents. Patients are advised to limit or avoid alcohol consumption while taking any medication that affects the central nervous system.

Q: Why does the packaging for Relestat (Adrenaline) emphasize the need for immediate medical help?

A: Official instructions stress that the medicine is an emergency first-aid treatment and is not a substitute for professional medical care. Immediate follow-up is necessary because severe allergic reactions can reoccur (biphasic reactions) or may require additional, ongoing treatment.

Q: Does Relestat (Adrenaline) have potential interactions with common antidepressants (SSRIs)?

A: Regulatory documents warn that certain antidepressant classes, such as tricyclic antidepressants, may potentiate the effects of Adrenaline. Regulatory guidelines advise informing a healthcare professional of all psychiatric medicines being used.

Q: Is it possible to be allergic to Relestat (Adrenaline) itself?

A: Official documents contraindicate the use of the medicine in patients with a known sensitivity to adrenaline or other sympathomimetic amines. This also applies to a known sensitivity to any of the inactive ingredients (excipients) in the product.

Q: What factors might make Relestat (Adrenaline) less effective?

A: Regulatory documents note that certain medical conditions, such as acidosis (high acidity), hypoxia (low oxygen), and hypercapnia (high CO2) may potentially reduce the effectiveness of the medicine in specific emergency scenarios.

Q: Is a follow-up hospital visit always needed after using Relestat (Adrenaline)?

A: Official instructions explicitly state that seeking immediate professional medical attention (e.g., calling emergency services) is necessary after use. The medicine is an emergency first-aid treatment only, and follow-up care is required even if symptoms improve.

Q: Does Relestat (Adrenaline) cause any long-term dependency or addiction issues?

A: The drug is not listed as a controlled substance by major regulatory bodies. Due to its short-lived effects and emergency nature, it is not associated with long-term chemical dependency or addiction in its approved therapeutic use.

Q: What evidence is there that Relestat (Adrenaline) is the standard treatment for a specific condition?

A: Medical authorities consistently describe Adrenaline as the 'first-line medication' and the 'only first-line medication' for the emergency management of anaphylaxis. This indicates its established status as the essential standard of care.

Q: Is it possible to travel internationally with Relestat (Adrenaline)?

A: While regulatory drug labels do not directly address international travel, manufacturer-provided resources often suggest that patients carry a 'Travel Certificate' or similar documentation. This can help travelers carry the necessary medical device internationally.

Q: Does Relestat (Adrenaline) affect the central nervous system?

A: Yes, official product information lists Nervous System Disorders and Psychiatric Disorders as potential adverse effects. These effects may include headache, tremor, anxiety, confusion, and psychomotor agitation.

Q: Can people with diabetes use Relestat (Adrenaline)?

A: Official documents list diabetes mellitus as a condition that requires caution during use. Patients with diabetes may be at risk of developing hyperglycemia (high blood sugar) after administration of the drug.

Q: Why is proper technique so important when using Relestat (Adrenaline)?

A: Official warnings emphasize avoiding injection into digits, hands, or feet. This is crucial because the drug causes vasoconstriction (blood vessel narrowing), and improper technique may lead to local complications due to lack of blood flow.

Q: What is the highest-level summary of the research evidence for Relestat (Adrenaline)?

A: Studies and expert opinion consistently recognize the drug's high efficacy as an essential emergency treatment. Despite a historical lack of controlled trials for this acute use, it is considered the established first-line treatment for anaphylaxis.

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How should Relestat (Adrenaline) be stored and disposed of?

Storage Requirements

Adrenaline injection must be stored at Controlled Room Temperature, defined as 20 to 25 C (68 to 77 F), with excursions permitted up to 30 C (86 F). The product must be protected from light and stored in the outer case or carrier tube provided. It must also be protected from freezing, as temperatures below 15 C may damage the device mechanism. The solution should be visually inspected; do not use the medicine if it appears pinkish, brown, cloudy, or contains any particulate matter. Keep the product out of the sight and reach of children.

Disposal Instructions

Adrenaline devices are for single use only. Used injectors, which contain a needle, must be immediately discarded in an approved sharps disposal container. Disposal of expired or unused products and any pharmaceutical waste must be conducted in accordance with local regulations and procedures.

Attention! Always consult to a doctor or pharmacist before using pills or medicines.

Available in countries:

Peru

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